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What’s In Your Tampon, and Should You Care?

The first time I worried about the ingredients in my Tampax Pearls was after seeing an ad for the organic alternative. “Do you know what’s in your tampons?” it asked. My answer was no, and for a long time, I didn’t want to know. But that was a few years ago, and the conversation around responsible and ethical feminine care has become much louder. For tampons, it’s particularly pointed: What they’re made of, how they’re taxed, where they go after disposal and why that matters. It’s the kind of curtain-pulling we’re seeing across a lot of industries right now.

Do we really need to worry?

There are plenty of people who think we do. Take Lola, the organic tampon subscription service whose site assures women: “We’re changing your period for the better, with feminine care that’s simple, natural, and easy to feel good about.” Or Cora, a similar service that promises, “A safer tampon. A sophisticated experience. An empowering cause.” Or Sustain Natural, a new offering in the world of organic, ethically minded period kits from Meika Hollender and her father Jeffrey, the founder of Seventh Generation. “Our 100% organic cotton tampons are rayon, fragrance, and chlorine free, because we believe you should only put good stuff inside yourself.”

These kinds of industry disruptors are helmed largely by young, activist-minded women seeking to educate consumers and, I presume, take business away from big players like Tampax and Kotex. They emphasize health, safety and goodwill. Many have charitable business models: Cora donates a sustainable sanitary product to a woman in need for every tampon it sells; Sustain donates 10% of its pre-tax profits to women’s healthcare organizations. Most also have an education or community arm aimed at providing resources to women beyond the products they’re selling.

The charitable and sustainable efforts may be reason enough for you to make the switch from a big-box brand, but in terms of personal health, the science is mixed. Organic tampons, as a health-conscious alternative, ride largely on one claim that’s been tricky to substantiate: that mainstream tampons are dangerous.

In The Daily Beast’s Keli Goff’s reported piece on tampons, the first three cited sources regarding the dangers of tampons are founders of feminine-care disruptors who stand to benefit from such findings (Jade and Pearl, Cloth Pad Shop, The Period Store). The two doctors she eventually cites are Dr. Rebecca Brightman, an ob-gyn who “cautioned that such fears are overblown,” and Dr. Joseph Mercola, who likens feminine hygiene products to “a ticking time bomb.”

Mercola’s thoughts on tampons are cited again and again in media coverage: take this piece in the Huffington Post, this piece in Time, this one on Bustle. His website is home to several articles outlining the dangers of traditional hygiene products. Mercola is not an MD but rather an osteopathic physician, who’s been written up more than once by Quackwatch for unsubstantiated claims and has been warned by the FDA and FTC several times for making false medical claims.

He harbors a clear distrust for the current scientific research, a view I’ve heard before. His approach, which assumes the FDA’s findings aren’t the whole story, is mirrored in other doctor testimonies. For instance, in Goop’s coverage of the topic, Dr. Maggie Ney says that while the modern manufacturing process for tampons produces almost undetectable traces of the toxin dioxin, and is considered safe by the FDA, she still feels, “that tampon companies underestimate the effects of dioxin.”

So what’s the right answer? Who can we trust? I reached out to Dr. Anita Mitra. She’s a practicing gynecologist and researcher based in London and the founder of Gynae Geek, a blog aimed at combatting misinformation. “With the internet flooded by websites and blogs full of poor quality, confusing information…there is a need for reliable, evidence-based information about women’s health,” her site reads. Fun fact: She tells me her surname, Mitra, is Greek for uterus.

She has a lot of thoughts on tampons. First, she warns me not to rely on Google when it comes to these matters, as a particularly worded search will tell you whatever you want to hear. (I can vouch for that!) I ask her to start with the basics, then. What are the supposed risks and why? “The main diseases people are associating with tampons are cancer and endometriosis…Pesticides and dioxin seem to be the two major compounds of concern,” she says.

Dioxin is a toxic compound, and the one most often associated with non-organic tampons. As the National Center for Health Research puts it: “Dioxin is the byproduct of the process from converting wood pulp into a synthetic fiber called Rayon…Tampons are usually made of cotton and rayon.” Until the late ’90s, bleaching of wood pulp to create tampons resulted in traces of dioxin, but that method has since been changed to a chlorine-free bleaching process. Traces of dioxin still remain, however, but “range from undetectable 0.1 to 1 parts per trillion.”

Is a lot? Nope. A 2002 study published in Environmental Health Perspectives found that, “exposure to dioxin in tampons…is thousands of times less than the dioxin people typically consume in the food they eat.”

There are a few reasons people are concerned by these “trace findings,” though: vaginal walls are highly absorptive, for one, and women might use around 10,000 tampons in their lifetime — might it add up? “Lots of people are talking about the accumulation of these products over a menstrual lifetime, but there is absolutely NO evidence to suggest they accumulate,” says Dr. Mitra.

She says while some small studies have linked dioxin with cancer or endometriosis, “they are performed in vitro (i.e. in the lab in a petri dish) or in animals, so we don’t really know if this translates to humans.” Quite simply, there is a lack of data.

Dr. Mitra says it’s impossible to draw conclusions until larger scale studies are conducted. “One of the main problems is the funding of such research. Major scientific bodies (e.g NIH in the U.S.) don’t seem interested in funding this research, and a well-controlled, large-scale study of thousands of women followed over many years would be necessary to determine whether particular types of tampons really do pose a threat.” As for toxic shock syndrome, she says there is no evidence to suggest this is more common with certain kinds of tampons over others. (A Vice piece from 2015 did tie synthetic fibers in tampons and absorbency levels to TSS.)

Why the sudden concern? Dr. Mitra chalks it up to wellness hype. “I see a trend towards this phenomenon with a healthy lifestyle in general.”

Aside from cautioning her own patients against fragranced feminine care products — “which can kill the healthy bacteria and cause bacterial vaginosis” — she says there is no right or wrong answers, and that it’s up to personal preference. She believes there are far more important health considerations than tampon choice. “I would say it’s a low priority compared to things like having a healthy diet, exercising regularly, not smoking or drinking too much alcohol and keeping stress levels low. Those are the five big hitters when it comes to preventing cancer and most other chronic diseases which cause death and ill health.”

Not everyone is of Dr. Mitra’s opinion, though. Take Laura Strausford, an attorney and the co-founder of Period Equity, a “law and policy institute dedicated to advancing menstrual access, equity and safety in the U.S.” She is passionate about getting tampons the attention they deserve from researchers, policymakers and women alike. “We’ve been able to study the health risks associated with tobacco use, alcohol and many other exposures,” she tells me. “Why haven’t we ever included a question about tampon use in long-term studies of women’s health?” She explains that congresswomen Carolyn Maloney has been asking the NIH to fund such a study for 20 years.

“I think women should worry at least as much about what’s in their tampons as they do their food and cosmetics,” Laura says. “What little we know about tampon ingredients — which are legally, but wrongfully protected as trade secrets — is of huge concern.” She’s referring to tampon companies not being required to list the ingredients on the box the way food and beauty companies are. In a recent interview with The New York Times, she referred to this secrecy as “the other tampon tax.” As in: in addition to the fact that tampons are often taxed as luxury items, the industry’s lack of transparency is a tax on women’s safety.

“Earlier this month,” reports the Times, “Representative Grace Meng, Democrat of New York, introduced a bill called the Menstrual Products Right to Know Act, which would require menstrual hygiene products — including tampons, pads, and menstrual cups – to list their ingredients on the package.” If passed, it could mean tampon companies have to own up to any potentially harmful ingredients used.

All of this is to say: There are plenty of reasons to choose and engage with feminine care products thoughtfully. Current research shows that potentially harmful ingredients are present, though in nearly undetectable amounts. Time and further studies may lead to new reveals. In the meantime, forward-thinking companies like Lola, Cora and Sustain are offering consumers ease of mind and are forcing big-box brands to be more transparent and ethically minded. It certainly can’t hurt.